Provider Demographics
NPI:1851113252
Name:SCRUGGS, MARK WAYLON (FNP-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:WAYLON
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39168-0291
Mailing Address - Country:US
Mailing Address - Phone:601-785-4322
Mailing Address - Fax:866-404-2914
Practice Address - Street 1:336 EUREKA STREET
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39168-0291
Practice Address - Country:US
Practice Address - Phone:601-785-4322
Practice Address - Fax:866-404-2914
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906998363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner